Individual provider Active NPI

Douglas CK Dang, MD

  • Emergency Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1114936796
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
21632 Issued in AZ
Practice address
1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone
(602) 839-6968
Fax
(602) 839-6968
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 21632 AZ Primary

Addresses

Primary practice location

1111 E McDowell Rd
Phoenix, AZ 85006-2612

Mailing address

645 E Missouri Ave Ste 300
Phoenix, AZ 85012-1351
Phone (480) 500-2540

Other identifiers 1

IdentifierTypeStateIssuer
145468MedicaidAZ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address douglas.dang@bannerhealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080516000558 AZ Practitioner - Emergency Medicine 9638070741 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Creighton University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21632AZMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince Mar 1, 2020 Accepting new patients
Emergency Professional Services PC Emergency Medicine CurrentSince Jan 1, 1990 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince Mar 1, 2020 Accepting new patients
Emergency Professional Services PC Emergency Medicine CurrentSince Jan 1, 1990 Accepting new patients
Emergency Professional Services PC Emergency Medicine Past Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

1300 N 12th St
Ste 301
Phoenix, AZ 85006
Phone (602) 239-6968

9201 W Thomas Rd
Phoenix, AZ 85037
Phone (623) 327-4000

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1114936796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 E MISSOURI AVE STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121351",
            "telephone_number": "480-500-2540",
            "fax_number": "623-201-7954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062612",
            "telephone_number": "602-839-6968",
            "fax_number": "602-839-6968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANG",
        "first_name": "DOUGLAS",
        "middle_name": "CK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "21632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145468",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "douglas.dang@bannerhealth.com",
            "affiliation": "N",
            "endpointDescription": "Banner University Medical Center - Phoenix",
            "address_1": "1111 E McDowell Rd",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850062612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.